The Clinical journal of pain
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Randomized Controlled Trial
Evaluation of efficacy of the perioperative administration of Venlafaxine or gabapentin on acute and chronic postmastectomy pain.
Postmastectomy pain syndrome is a neuropathic pain syndrome that is known to develop after breast surgery. Preemptive analgesia has been shown to be efficacious in reducing postoperative pain, and may be effective in reducing the incidence of certain types of neuropathic pain. We investigated the analgesic efficacy of Venlafaxine and gabapentin on acute and chronic pain associated with cancer breast surgery. ⋯ Venlafaxine 37.5 mg/d extended release or gabapentin 300 mg/d have equipotent effects (except on the first day in venlafaxine group) in reducing analgesic requirements, although gabapentin is more effective in reducing pain after movement. Venlafaxine significantly reduced the incidence of postmastectomy pain syndromes (chronic pain) 6 months in women having breast cancer surgery. Gabapentin had no effect on chronic pain except decreasing incidence of burning pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder: a prospective, randomized, single-blinded study.
Chronic shoulder pain treatment is known to be a difficult and long process. The objective of this study is to compare the efficacy of intra-articular corticosteroid injection and pulse radiofrequency (PRF) applied to the suprascapular nerve in patients with shoulder pain. ⋯ Intra-articular injection of corticosteroid and PRF applied to the suprascapular nerve are effective in the treatment of painful shoulder. When 2 treatments are compared, it may be concluded that intra-articular steroid injection was more effective especially in the first weeks regarding pain than the PRF. Further studies are needed to confirm these results in the prospective treatment guidelines.
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The use of strong opioids for treatment of noncancer chronic pain has increased. However, strong evidence for sustained pain relief and improved function is lacking. Controversy prevails, whether hormonal changes are induced by long-term treatment with opioids. The purpose of this study was to investigate the occurrence of endocrine dysfunction in chronic pain patients on long-term opioid treatment. ⋯ Long-term treatment of chronic pain with strong opioids causes side effects that can be attributed to hormonal abnormalities caused by opioid-induced inhibition of hypothalamic-pituitary function. Hormone substitution can be indicated to treat symptoms. Decreasing the opioid dose or stopping the opioid treatment can reverse endocrine dysfunction. This needs to be recognized by all practitioners treating chronic pain patients with opioids.
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Randomized Controlled Trial
Transcutaneous pulsed radiofrequency treatment in patients with painful knee awaiting total knee joint replacement.
Our study was designed to determine if transcutaneous-pulsed radiofrequency treatment (TCPRFT) was able to reduce the pain experienced by patients awaiting total knee joint replacement (TKJR). We conducted a randomized, double-blinded, placebo controlled trial of TCPRFT in patients referred for TKJR to our hospital's Orthopedic Outpatient Clinic. ⋯ We believe this to be the first report of a controlled study of TCPRFT. This pilot study shows a benefit of the technique that justifies future research.
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Opioids are indicated for the management of procedural pain in neonates. There are limited data describing factors influencing patterns of use. ⋯ Neonatologists frequently report using opioids to manage procedural pain, however, spontaneously breathing infants are less likely to receive them, and their use varies according to infant and procedure characteristics. These data point to the need to further investigate, in a more controlled design, the pharmacologic effects of opioids in this population to better guide clinicians about their optimal use.